FAMILY PLANNING

PREPARED BY:

KIETH C. SERESULA, RM, BSM

What is Family planning???
• Is the decision-making process by couples, together or
individually, on the number of children that they would like to
have in their lifetime, and the age interval between children.

•This means that both halves of a couple have equal rights to

decide on their future fertility. In planning their future
children, partners need to have the right information on when
and how to get and use methods of their choice without any
form of coercion. Such planning therefore helps mothers and
their children enjoy the benefits of birth spacing and having
planned pregnancies.
OBJECTIVES
1. The FP program addresses the need to help couples
and individuals achieve their desired family size
within the context of responsible parenthood and
improve their reproductive health to attain
sustainable development.

2. It aims to ensure that quality FP services are available

in DOH-retained hospitals, LGU-managed health
facilities, NGOs, and the private sector.
 THE PHILIPPINE FAMILY PLANNNG
PROGRAM
VISION:

To empower women and men to live

healthy, productive and fulfilling lives with the right
to achieve their desired family size through quality,
medically sound, and legally permissible FP
methods
MISSION:
The DOH, in partnership with the LGUs,
NGOs, private sector, and communities shall ensure
the availability of FP information and services to
men and women

GOAL:
To provide universal access to FP information
and services whenever and wherever these are
needed
 BENEFITS OF FAMILY PLANNING
A. BENEFITS TO MOTHER

• Significant reduction in maternal mortality and

morbidity
1. Reduces maternal deaths by preventing high risk pregnancies
among women who are too young, too old, or too ill to bear
children safely.
2. Maternal deaths can be prevented if unwanted pregnancies are
avoided and pregnancies are spaced by at least three years.
• FP prevents closely spaced pregnancies that leads to and
worsen conditions such as anemia and maternal
malnutrition.
• Non-contraceptive health benefits of hormonal contraceptives
 studies show that combined oral contraceptives provide
significant non-contraceptive health benefits. They are known
to prevent/reduce the incidence of the following diseases and
conditions:
a) ectopic pregnancy
b) ovarian cancer
c) endometrial cancer
d) ovarian cyst
e) benign breast cancer
f) excessive menstrual bleeding and associated anemia
g) menstrual cramping, pain and discomfort
 all FP methods help women with HIV avoid pregnancy thus
avoiding bearing HIV-infected children.
B. BENEFITS TO INFANTS AND CHILDREN
•Reduction in infant and child mortality and morbidity
 
C.BENEFITS TO FATHERS
provides fathers who are suffering from chronic illnesses
(diabetes, hypertension) enough time for treatment and recovery from
those illnesses

lightens his burdens and responsibilities in supporting his family

since he will only be providing few children he can afford to
support.
 Enables him to give his children a good home, a good education,
and a better future

 gives time for his own personal achievement

 enables him to have time and opportunity to relate with his wife
and play with his children

 affords him extra resources and enough time to actively

participate in community program and projects
 r ! !!
mb e
m e
Re
The total risks of birth control are
much less than the total risks of a
pregnancy!!
Menstrual Cycles
Menstrual Cycle
Menstrual cycle begins on the first day of menstrual bleeding
and ends on the day before menstrual bleeding begin again.

PHASES OF THE MENSTRUAL CYCLE

1. Pre- Ovulatory Phase (Menstrual Phase)

-On the first day of the menstrual cycle, estrogen and
progesterone levels are low. This cause the shedding of the
endometrium as menstrual bleeding.

-The low level of estrogen and progesterone stimulates the

brain to produce FSH. This hormone as it is called, stimulates the
follicle in the ovary to mature. One of these follicles will later further
mature to be released during ovulation.

- The maturing follicles in the ovary produce estrogen. As the

follicles mature further, the estrogen levels increase.
 Menstrual Cycle cont.
Estrogen causes:
- endometrium to thicken by cell multiplication and proliferation
-Production of mucus to become increasingly wet and lubricative.

2. Ovulatory Phase (Follicular Phase)

- When estrogen levels peak, the brain is stimulated to produce LH.
This sudden increase of LH causes the release of the mature ovum, a
process which is called OVULATION.

- Ovulation occurs 12-16 days before the onset of the next menses.
- Once ovulation occurs and the egg has gone into the fallopian tube,
it can be fertilized by the male sperm for only up to one day (24 hrs).

During this Phase:

- The lining of the uterus continues to thicken
-The egg is mature and is finally released.
- The cervical mucus is wet, slippery, stretchy, and clear.
- There is a feeling of vaginal wetness.
- The cervix is soft and open.
 Menstrual Cycle cont.
3. Post- Ovulatory Phase ( Luteal Phase)

- After ovulation, the remaining follicles that underwent initial

maturation are transformed into the corpus luteum.
- The corpus luteum in the ovary produces estrogen in smaller
amounts and progesterone in greater amounts. This causes a drop in
estrogen levels with higher levels of progesterone.

Progesterone causes the following changes in the woman’s reproductive system:

-The cervical mucus becomes pasty and is no longer slippery and stretchy.
- The vagina feels dry( this type of mucus does not allow the sperm to travel into
the uterus and prevents the sperm from living for more than a few minutes to a
few hours).
-The cervix becomes firm; the cervical opening closes so that sperm cannot pass
through to the uterus.
- The basal body temperature increases and remains high for the rest of the
cycle.
Menstrual Cycle cont.
-When there is no fertilization, the corpus luteum regresses. As the
corpus luteum regresses, the production of progesterone and
estrogen decreases.

- When progesterone and estrogen levels are low, menstruation

occurs.
FP PROGRAM METHODS

A.PERMANENT METHODS
-Female sterilization/Bilateral tubal ligation
-Male sterilization/Vasectomy

B. TEMPORARY METHODS
1.Fertility awareness-Based method

Cervical Mucus/Billings Ovulation Method

Basal body temperature
Sympto-thermal Method
Standards Days Method
Lactational Amenorrhea Method
2. SUPPLY METHODS

Pills
contraceptive patch
Intrauterine Device
Injectable
Male condom
implant
FERTILITY AWARENESS-BASED METHODS
Are family planning methods that focus on the awareness of the
beginning and end of the fertile time of a woman’s menstrual
cycle.
These methods involve:
Determination of the fertile and infertile periods of a woman
within the menstrual cycle.
Observation of the signs and symptoms of fertility and
infertility during the menstrual cycle.

•EFFECTIVENESS: All methods are above 95% effective

SIGNS OF FERTILITY
•Changes in cervical mucus: cervical mucus can be used to
determine the beginning and end of fertile days.

•Changes in the basal body temperature: Basal body

temperature can be used to determine when ovulation has
passed and the fertile days have ended.

•The first day of menstruation is the sign for keeping track

of a woman’s menstrual cycle.
ADVANTAGES
1. Safe and has no side effects.
2. Inexpensive
3. Acceptable to religious affiliations that do not
accept artificial method of contraception.
4. Helpful for planning pregnancy and avoiding
pregnancy.
5. Promotes communication about family planning
and contraception between couples.
DISADVANTAGES
1. Involves long preparation and intensive recording before it can
be used.

2. There is a need to abstain on certain days which may be

inconvenient for the couple.

3. Not ideal to women with irregular cycle.

4. Not very reliable because of menstrual cycle variations that

may occur anytime.
THE FAB METHODS

1.CERVICAL MUCUS/ BILLINGS OVULATION

METHOD (CMM/BOM)

• This form of contraception is based on the changes in

cervical mucus during the menstrual cycle.
 
• Before ovulation, the normal vaginal discharge is either
absent or it is thick and scant. Just before ovulation,
mucus discharge becomes clear, abundant. Slippery and
stretchable due to high estrogen level. Ovulation most
likely occurs 24 hours after the last day of the abundant
slippery and thin discharge.

 Ovulation is assumed to have occurred anytime in the 2

days before and after the mucus peak and the time when
cervical discharge is most abundant.
Conditions affecting the cervical mucus pattern in
women
If a woman has a vaginal or cervical infection.
If a woman has recently had sexual stimulation
(which will increase vaginal secretions).
If a woman is currently taking drugs for colds or
sinusitis, which may dry up mucus secretions.
If a woman is in physical or emotional stress.
CLIENT INSTRUCTION
Fertile Period: As soon as you notice your mucus to be abundant,
slippery, watery, thin and stretchable, consider yourself fertile.
Avoid yourself intercourse.
Infertile Period: Mucus is thick, scant, and yellowish or absent.
Sexual intercourse is allowed every other day.
Check vagina each time you go to the bathroom. Insert a finger or
dap vaginal entrance with toilet tissue. Compare mucus changes and
degree of wetness each day. Record observation on a chart.
Douching, vaginal infections, foams, semen, diaphragm jelly,
lubricants, some medications and lubrication from sexual arousal
can alter mucus findings.
2. BASAL BODY TEMPERATURE:
is on temperature changes during the cycle.
 BBT is lowest during waking hours which is obtained in the morning upon
waking up.
 BBT during menses and the days before ovulation usually varies from 97.2F
to 97.4F.
 About 12 to 24 hours before ovulation, BBT drops by 0.4 to 0.8F due to the
very low progesterone level.
 The drop in temperature is followed by a sudden rise by about 1F after
ovulation due to increasing progesterone levels produced by corpus luteum.
The temperature remains elevated until 2 to 4 days before menstruation.
 The woman is fertile from the day of the drop in temperature until the 3 rd
day of elevated BBT.
 The woman should avoid coitus during these fertile days or starting from day
1 of the cycle to the third day of elevated BBT.
CLIENT INSTRUCTION

It is necessary to record the temperature very morning before

getting out of bed for at least 3 months before using this method.
When using BBT method, take her temperature every morning after
at least 3 hours of sleep and before doing anything.
Any site for temperature taking is acceptable but the same site
should be used always.
Lack of sleep, infection, fatigue, awakening late and anxiety can
cause temperature fluctuation.
3. SYMPTO-THERMAL METHOD: Is based on the combined technology of
the basal body temperature and the cervical mucus/Billings ovulation
method together with other signs which indicate that the woman is
fertile or infertile. This method is 98% effective as correctly used.

4. STANDARD DAYS METHOD (SDM): Is based on a calculated fertile

and infertile period for menstrual cycle lengths that are 26 to 32
days. Woman who are qualified to use this method are counseled
to abstain from sexual intercourse on days 8-19 to avoid pregnancy.
Couples on this method use a device, the color-coded “cycle
beads”, to mark the fertile and infertile days of the menstrual
cycle. SDM is 95.25% effective with correct use and 88% with
typical use.
HOW TO USE THE CYCLE BEADS

- Assess the length of the menstrual cycle if it falls within the

range of 26-32 days by considering the following information:

 The last menstrual period

 The previous/ past menstrual period
When she expects her next menses
- If the cycle length is less than 26 days or more than 32
days, the client cannot use the method.
- If the cycle meets the criteria, provide an SDM card and
cycle beads, which can be used in marking the days of the
cycle.
 Show the woman the cycle beads and instruct her on how to use it:

-On the first day of the menstrual cycle (first day of menstrual bleeding),
she puts the ring on the red bead and marks with an “x” the date on the
calendar.
-She puts the ring to a bed each day. It is recommended that she moves
the ring every morning upon waking up so that she does not forget. The
brown beads signify infertile days while the white beads signify fertile
days.
-When the ring is on a white bead, she abstains from sexual intercourse.
WOMEN WITH SPECIAL CONDITIONS
Contraceptive shifters may also use SDM provided that the following criteria are met:

* Shifting from pills

-Menstrual cycle were within 26-32 days before taking the pill
-Expects current cycle to be within 26-32 days.
* Shifting from injectable
-At least three months have passed since the last injection
-Menses have returned
-Menstrual cycles were within 26-32 days before using the injectable
-last menstrual cycle was within 26-32 days.
*Recently used IUD
-IUD has been removed
-Menstrual cycles while using the UID were within 26-32 days
-Last menstrual cycle was within 26-32 days.
*Postpartum and/or Breastfeeding
-Menstruation has returned
-Has had at least four normal menstrual period
-Expects current cycle to be within 26to 32 days.
1. LACTATION AMENORRHEA METHOD (LAM): is
contraceptive method that relies on the condition of
infertility that results from specific breastfeeding
patterns. LAM is the use of breastfeeding as a
temporary family planning method. “Lactational”-
means related to breastfeeding. “Amenorrhea”- means
not having menstrual bleeding.

• CRITERIA FOR LAM

1. The woman exclusively breastfeeds infants.
2. Amenorrhea
3. Infant is less than six months old.
MECHANISM OF ACTION
•Works primarily by preventing the release of eggs
from ovaries (ovulation). Frequent breastfeeding
temporarily prevents the release of the natural
hormones that cause ovulation.
EFFECTIVENESS
•Perfect use: 99.5%
•Typical used: 98%
ADVANTAGES OF LAM

-Can be started immediately after delivery

-economical and easily available
-does not require a prescription
-no action is required at the time of intercourse
-no side effects or precautions to its use
-no commodities or supplies are required for clients or for the
family planning program
-fosters mother-child bonding
-serves as a bridge to using other methods since LAM is used
for a limited time only
-is consistent with religious and cultural practices.
DISADVANTAGES OF LAM

•-Full or nearly full breastfeeding pattern may be difficult for some

women to maintain
•-The duration of the method’s effectiveness is limited to a brief six-
month postpartum period. If the mother and child are separated for
extended periods of time, the breastfeeding practice required for
LAM cannot be followed
•-there is no protection against sexually transmitted infections,
including HIV
•-In addition, it may be difficult to convince some providers who are
unfamiliar with the method that LAM is a reliable contraceptive.
LOW-DOSE COMBINED ORAL CONTRCEPTIVES

•Low-dose COCs, otherwise known as pills or oral contraceptives,

contain hormones similar to the woman’s natural hormones-
estrogen and progesterone. They are taken daily to prevent
contraception.
•Two types of pill packets are available in the Philippines. One type
has 28 pills in a packet, with 21 “active’ pills containing hormones
and seven inactive or reminder” pills of a different color. The
reminder pills do not contain hormones. Another type of pills
contain only 21 “active/hormone containing” tablets.
MECHANISM OF ACTION

•Low-dose COCs prevents ovulation by suppressing

FSH and LH. It also causes thickening of the cervical
mucus, which makes it difficult for sperm to pass
through.

EFFECTIVENESS
•Perfectly used: 99.7%
•Typically used: 92%
Factor affecting effectiveness

1.Correct and consistent use.

2.Proper storage, observance of shell life,
and expiration date.
3.Vomiting or diarrhea
4.Drug interactions
ADVANTAGES

Safe as proven by extensive studies

Reversible, rapid return of fertility
Convenient, easy to use, no need to do anything at the time of
sexual intercourse
has significant non- contraceptives benefits
monthly periods regular and predictable
reduces symptoms of gynecologic conditions such as painful
menses and endometriosis
reduces the risk of ovarian and endometrial cancer
decreases risk of iron- deficiency anemia
can be used at any age from adolescence to menopause
DISADVANTAGES

Requires regular and dependable supply

Client dependent: effectiveness depends on the client’s compliance
to the daily routine of taking the pills. Often not used correctly and
consistently, this lowers its effectiveness. Strong motivation to take
pills correctly is needed.
Offers no protection against STIs/HIV
Not most appropriate choice for lactating women as it can suppress
lactation
Effectiveness may be lowered when taken with certain drugs such as
rifampicin and most anti- convulsants.
Increased risk to users over 35 years old who smoke and have other
health problems.
 SIDE EFFECTS

Spotting
amenorrhea
nausea
breast tenderness
headaches
 WARNING SIGNS
J-JAUNDICE
A-ABDOMINAL PAIN
C-CHEST PAIN
H-HEADACHES (SEVERE)
E-EYE PROBLEMS such as brief loss of vision,
seeing flashes of light
zigzag lines
S-SEVERE LEG PAINS
CLIENT INSTRUCTION

- Advice the client to take one pill a day regularly, preferably at the
same time, even if she is not having sex daily.
- A pack of 21 pills containing the “active” hormones estrogen and
progesterone. This requires a seven- day rest period before starting a
new pack.
- A 28-day pack would contain seven additional placebo or non-
hormone tablets of a different color to enable the woman to finish the
pack and start a new one immediately. No rest period required.
- It is best that COCs are taken within the first five days of the
menstrual period since conception is virtually nil at this time.
- If a woman started COC after the 7th day of onset of here menses,
she should practice abstinence or use back up contraceptive for the
next 7 days.
 CONTACEPTIVE PATCH

The contraceptive patch is a form of contraceptive applied

to the skin. It contains estrogen and progestin similar to
the natural hormones in a woman’s body and released
slowly in the bloodstream.
 

MECHANISM OF ACTION
Inhibiting ovulation
thickening of the cervical mucus
ADVANTAGES
Effective (99%)
no daily pill intake
regulates menstrual flow such that monthly cycles are regular, lighter, with fewer
days of bleeding
can be stopped at any time by the client
does not interrupt sex
increased sexual enjoyment as there is no need to worry about getting pregnant
convenient and simple to use
safe
has significant non- contraceptive benefits similar to COCs
 Monthly periods are regular and predictable
 Reduces symptoms of gynecologic conditions such as painful menses and
endometriosis
 Reduces the risk of ovarian and endometrial cancer
Decrease the risk of iron deficiency anemia
Can be sued at any age from adolescence to menopause
DISADVANTAGES
Pregnancy
Smoking and are 35 years old or over
35 years old or over and stopped smoking less than a year ago
Breastfeeding
Overweight
History of thrombosis
Heart disease
POSSIBLE SIDE EFFECTS
Skin irritation or rashes at the site of the patch
Headache
Menstrual bleeding irregularities
Fluid retention
Nausea
Breast tenderness
MISSED PATCH CHANGES

•If the client forgets to change the patch at the beginning of a

monthly cycle, apply one as soon as remembered. Record this
day of the week as the new patch change day and use as a back-
up method of birth control for the next seven days

•If the client forgets to change the patch by one or two days in
the middle of the monthly cycle, change patch as soon as
remembered. Keep the same patch change day. A back- up
method is not required.
• If the client forgets to change the patch by more than two
days in the middle of the cycle, put a new patch as soon as
possible. Begin a new four- week patch cycle with this patch.
Record the day of the week and use a back- up method of
birth control for the next seven days.

• If client forgets to remove the third patch in the cycle.

Remove it as soon as remembered. Apply a new patch as
scheduled to start the next patch cycle. No need to change
the regular patch change day or use a back- up contraception.
WARNING SIGNS
•J-JAUNDICE
•A-ABDOMINAL PAIN
•C-HT PAIN
•H-HEADACHES
•E-EYE PROBLEMS
•S-SEVERE LEG PAINS
 COMBINED INJECTABLE

•The combined injectable is a contraceptive containing

estrogen and progestin in an injectable form.
•The currently available combined injectable in the country
contains Norethisterone 5omg and estradiol Valerate 5mg in
oily solution.

MECHANISM OF ACTION
•The contraceptive effect is primarily on ovulation inhibition
and thickening of the cervical mucus.
•The contraceptive effect is similar to that achieved by daily
intake of the COC.
ADVANTAGES
Does not require daily action. No need to take pill daily.
Private. No one else can tell that the woman is using a contraceptive.
More regular monthly bleeding as compared to DMPA.
DISADVANTAGES
Requires injection every months
Delayed return to fertility after the woman stops the method. It
takes an average of one month for fertility to return.
Does not protect against STIs/HIV
•EFFECTIVENESS
•Correct use: 99%
•Typical use: 97%
 POSSIBLE SIDE EFFECTS

1.Changes in the monthly bleeding which will lessen within the

three months of starting injections include:
Lighter and fewer days of bleeding
Irregular bleeding
Infrequent or prolonged bleeding
No monthly bleeding

2.Headaches
3.Dizziness
4.Breast tenderness
WHO CANNOT USE

Pregnancy
Breastfeeding an infant that is less than 6 mos. old
Smoke cigarettes and are 35 years old or older
Hypertension
Migraine headaches
Serious diseases of the liver, heart or blood vessels
Breast cancer
Undiagnosed abnormal vaginal bleeding
HOW TO USE
First injection is given on the first day of menstrual cycle.
Succeeding injections are given every 30+/- three days.
The injectable must be stored at controlled room
temperature 15-30 degree Celsius. Do not freeze.
Administration:
Follow injection prevention measures for administering
injections
Slow deep IM injection preferably intra gluteal,
alternatively into the upper arm
Place a plaster over the injection to prevent any reflux of
the solution
Client instruction:
What to expect:
-Vaginal bleeding episode will occur within one or two weeks after the first injection.
This is normal and if use is continued, bleeding episodes will occur at 30 days interval.
Pregnancy should be ruled out if no withdrawal bleeding occurs within 30 days after
an injection.

Follow- up
-Return to the clinic every 30 days for your next injection. Try to come on time.
-If, for some reason, the next injection was not given after 30days, abstain from sexual
intercourse or use a condom until you get the next injection.
-Come back to the clinic no matter how late you are. You may still be able to use
injectable.
-Return to the clinic at any time if;
•You develop any of the warning signs
•You have any questions or problems
•You think you are pregnant
 WARNING SIGNS
J-JAUNDICE
A-ABDOMINAL PAIN
C-CHEST PAIN
H-HEADACHES
E-EYE PROBLEMS
S-SEVERE LEG PAINS
 PROGESTIN –ONLY PILLS (POPs)

A type of pill usually available in a 28 tablet package

MECHANISM OF ACTION
1.Prevents ovulation in about half of menstrual cycles
2.Causes thickening of the cervical mucus. Which make it
more difficult for sperm to pass
EFFECTIVENESS
•Perfect use: 99.5%
•Typical use: 99%
ADVANTAGES
Can be used by nursing mothers starting 6 weeks after childbirth.
Quality and quantity of breast milk are not affected.
No estrogen side effects
Women take one pill every day with no break. Easier to
understand than taking 21- days combined pills.
Can be very effective during breastfeeding
Lesser risk of progestin- related side effects, such as acne and
weight gain, than with low-dose combined oral contraceptives.
May help prevent:
Benign breast cancer
Endometrial and ovarian cancer
Pelvic inflammatory disease
ADVANTAGES
Women who are not breastfeeding experiences changes in menstrual
bleeding. This includes irregular period, spotting or bleeding between
periods (common), and amenorrhea possibly for several months (less
common). A few women may have prolonged or heavy menstrual
bleeding.
Less common side effects include headaches and breast tenderness
Must be taken at about the same time each day to be effective. For
women who are not breastfeeding, even taking a pill more than three
hours late increases the risk of pregnancy and missing two or more pills
increases the risk greatly.
Does not protect against STIs/HIV
Effectiveness is lowered when certain drugs for epilepsy (phenytoin
and barbiturates) or tuberculosis (rifampicin) are taken.
 POSSIBLE SIDE EFFECTS

1.Amenorrhea
2.Irregular bleeding
3.Ordinary headaches
4.Nausea or dizziness
 STARTING POPs
Menstruating
Start within the first five days of the menstrual cycle.
Preferably on the first day
At any time during the menstrual cycle if reasonably sure
that the woman is not pregnant
If not within the first five days of the menstrual cycle= abstain
from sex or use a back- up method for the next two days
Postpartum
If breastfeeding. Start after six weeks postpartum
If not breastfeeding, can start immediately or at any time
within six weeks postpartum
 INSTRUCTION ON USE

-Briefly explain how POPs work to prevent pregnancy

-Show and let the client handle a package of pills
-How to manage missed pills
Remember to emphasize the importance of not forgetting any pill,
even just for a few hours
Advice the client that if she misses one or more pills, she may have
spotting or breakthrough bleeding, and more importantly she will be at
a greater risk of becoming pregnant
She needs to restart taking the pills as soon as possible
If she missed taking the pills by more than three hours, advise her to
abstain from sexual intercourse or use a barrier method of
contraception during the first 48 hours after restarting the pills.
 If the client is breastfeeding and amenorrheic and has missed one or
more pills by more than three hours, she needs to take the pill as usual.
- Keep track of your periods while you take POPs. If you have more than
45 days with no period, see your health care provider for an examination
and pregnancy test.
- If you have spotting or bleeding between periods, keep taking the pills
on schedule. If your bleeding is very heavy, or if you have pain, fever r
cramps, return to the clinic. In most cases, the bleeding is not serious
and will stop In a few days. Bleeding is especially likely if you have
missed a pill. Bleeding will be more common I the first months that you
take the pill.
- If you decide to get pregnant, plan to stop your pill two months before
you want to get pregnant and use another method like the condom. This
gives time for your normal cycle to reestablish itself and makes it easier
for your health care provider to determine your pregnancy due date.
 PROGESTIN-ONLY INJECTABLES

•The progestin- only injectable is a three- month injectable contraceptive. POI

contains a synthetic progestin, which resembles the female hormone
progesterone. Each standard dose contains 150 mg of the hormone, which is
released slowly into the blood stream from the site of intramuscular injection,
providing the client/user with a safe and highly effective form of contraception.

POIs commercially available in the Philippines:

1.Depot medroxyprogesterone acetate (DMPA), which is given every three
months
2.Norethisterone enanthate (NET- EN), which is given every two months.
MECHANISM OF ACTION
Inhibits ovulation
Thickens the cervical mucus
EFFECTIVENESS
•Perfectly used: 99.7%
•Typically used: 97%

ADVANTAGES
Reversible
No need for daily intake
Does not interfere with sexual intercourse
Perceived as culturally acceptable by some women
Private since it is not coitally dependent
Has no estrogen-related side effects such as nausea, dizziness, nor serious complications such
as thrombosis or pulmonary embolism
Does not affect breastfeeding- quantity and quality of breast milk do not seem to be affected.
Has beneficial non- contraceptive effects:
Helps prevent iron deficiency anemia
May make seizures less frequent in women with epilepsy
Reduces the risk of ectopic pregnancies
Prevents endometrial cancer
DISADVANTAGES
Return to fertility is delayed- on the average, fertility returns for
about 10 months from the last injection
Requires an injection every two or three months to sustain its effect
Does not protect against STI/HIV/AIDS
Menstrual irregularity during the first few months of use
Amenorrhea
Not possible to discontinue immediately, until DMPA is cleared
from the woman’s body.
There may be a decrease in bone density for long term users.
However, studies show that this condition is reversible after
discontinuation and that bone density loss is greater during
pregnancy.
 TIMING FOR THE FIRST INJECTION
FOR “INTERVAL” CLIENT
Any time it is reasonably certain that the woman is not pregnant
Within seven days of the menstrual cycle, the client needs no
backup method
After seven days of the menstrual cycle, a advise the client to use
a backup method or to exercise abstinence for the next seven
days.
FOR BREASTFEEDING CLIENTS
As early as six weeks after delivery
•If menses have resumed, the woman can start direct any time it
is reasonably certain that she is not pregnant.
 FOR POSTPARTUM, NOT BREASTFEEDING
 Immediately or at any time in the first six weeks after childbirth;
the client does not need to wait for her menstrual period
 After six weeks, any time she is reasonably certain that she is
not pregnant. If she is not certain. She should avoid sex or use
condom until her first menstrual period or until the possibility of
pregnancy has been ruled out.

 FOR POST ABORTION

 Immediately or within seven days after an abortion
 If later than seven days, any time it is reasonably certain that
she is not pregnant. She should avoid sex or use condom for the
next seven days.
 MALE CONDOM
•The condom is one of the barrier methods. Barrier methods
mechanically or chemically prevent fertilization or the union of the
egg and sperm. The male condom is the only FP method included
in the Philippine FP program that prevents both pregnancy and
sexually- transmitted infections.
•The condom is a sheath made of thin, latex rubber designed to fit
over a man’s erect penis.
MECHANISM OF ACTION
Prevents entry of sperm into the vagina
Sperm and disease- causing organism including HIV do not pass
through intact latex rubber or polyurethane condoms
Some condoms have a spermicidal coating which adds to its
effectiveness

EFFECTIVENESS
•Correctly used: 98%
•Typically used: 85%
ADVANTAGES

Protects against sexually- transmitted disease, including HIV

Easy to use
Usually easy to obtain
Inexpensive
Safe, effective, and portable
Helps protect against cervical cancer through prevention of
HPV infection
Allows men with premature ejaculation or to maintain erection
Convenient for short- term contraception
DISADVANTAGES

Coitus – related
Decreased sensitivity
Interrupts the sexual act
Slipping off, tearing, spillage of sperm can occur, especially
among inexperienced users
Allergy to latex (rare)
Requires high motivation for consistent and correct use
Deteriorates quickly when storage condition are poor
Causes some men difficulty in maintaining erection
HOW TO USE THE CONDOM
Do not use the condom that are expired or when the package is
perforated
Use the condom before the penis comes in contact with the partner’s
mouth, anus or vagina
If the penis is uncircumcised, pull the foreskin back before putting on the
condom. Keep the condom on the penis until after intercourse or
ejaculation
If the condom breaks or falls off during intercourse but before
ejaculation, stop and put on a new condom. A new condom can also be
used when you have prolonged intercourse or different types of
intercourse within a single session
Use a new condom from “start to finish” with each act of vaginal, oral or
anal intercourse. Do not reuse condoms.
 Take off the condom without spilling semen on the vaginal
opening by the holding the rim of the condom while withdrawing
the penis
 Adequate lubrication is important in the condom use and there
are lubricants which can and cannot be used with latex condoms.
If lubrication is needed:
 For latex condoms, use only water- based lubricants like
water, lubricants or spermicidal creams, jellies, foam or
suppositories
 Avoid oil- based lubricants like cold cream, mineral oil,
cooking oil, petroleum jelly, body lotions, massage oil, or baby
oil that can damage latex condoms
 For polyurethane condoms, any type of lubricant can be used.
 INTRAUTERINE DEVICE
•Types of IUD
1.Copper bearing, which includes the TCu380A (TCu380A, TCu380A
with safe load, and TCu200), the multi load (MLCu250 and Cu375), and
the Nova T
2.Medicated with a steroid hormone, such as mirena@, the
levonorgestrel- releasing intrauterine system (LNG- IUS)
•The main IUD featured in this learning package is the TCu380A (or
Copper T), which is:
Widely used
Well known for its effectiveness, ease of insertion and removal, wide
margin of safety, acceptability to clients, and low cost
Effective for at least 12 years
MECHANISM OF ACTION
•Act primarily by preventing fertilization. Copper ions
decreases sperm motility and function by altering the uterine
and tubal fluid environment, thus preventing sperm from
reaching the fallopian tube and fertilizing the egg.
EFFECTIVENESS
•Failure rate: less than 1% (0.8%)
EFFECTIVE LIFE
At least 12 years ( united Nations Development Programme
et al.1997)
10 years (United States Food and Drug Administration/USDA)
ADVANTAGES
Highly effective and very safe
Reversible and economical
May be safely used by lactating and immediate postpartum
women
Good choice for women who cannot use the other methods
Long duration of use
Once inserted, they are convenient and extremely easy to use,
providing worry- free continuous protection
Allows privacy and control over her fertility
Does not interact with medications client may use
No systemic side effects as its effects are confined to the uterus
DISADVANTAGES
Requires pelvic exam to insert the IUD
Requires a trained health services provider to
insert/remove the IUD
Does not protect against STIs
Increases the risk of PID for women with STIs
Device may be expelled, possibly without the
woman knowing it
HEALTH RISK
Uterine perforation
Expulsion
Infection

POSSIBLE SIDE EFFECTS

Menstrual changes
Changes in bleeding patterns, such as spotting/light
bleeding (between periods)
Discomfort or cramping
 WARNING SIGNS
P-PERIOD LATE
A-ABDOMINAL PAIN
I-INFECTION
N-NOT FEELING WELL
S-STRINGS MISSING OR LONGER
 Contraceptive implant
• The contraceptive implant is a small flexible tube about 40mm long
that's inserted under the skin of your upper arm. It's inserted by a
trained professional, such as a doctor, and lasts for three years.
• The implant stops the release of an egg from the ovary by slowly
releasing progestogen into your body. Progestogen thickens the
cervical mucus and thins the womb lining. This makes it harder for
sperm to move through your cervix, and less likely for your womb to
accept a fertilized egg.
• Nexplanon is a small, thin, flexible tube about 4cm long. It is
implanted under the skin of your upper arm by a doctor or nurse. A
local anesthetic is used to numb the area. The small wound made in
your arm is closed with a dressing and does not need stitches.
• Nexplanon works for up to three years before it needs to be
replaced. You can continue to use it until you reach the
menopause, when a woman’s monthly periods stop (at
around 52 years of age). The implant can be removed at any
time by a specially trained doctor or nurse. It only takes a
few minutes to remove, using a local anesthetic.
• Nexplanon is the main contraceptive implant currently in
use. Implants inserted before October 2010 were called
Implanon. Since October 2010, insertion of Implanon has
decreased as stocks are used up, and Nexplanon has become
the most commonly used implant.
 Implants are placed in the body filled
with hormone that prevents pregnancy
 Physically inserted in simple 15 minute
outpatient procedure
 Plastic capsules the size of paper
matchsticks inserted under the skin in
the arm
 99.95% effectiveness rate
MECHANISM OF ACTION
The implant steadily releases the hormone progestogen into your
bloodstream. Progestogen is similar to the natural hormone
progesterone, which is released by a woman's ovaries during her
period.
The continuous release of progestogen:
stops a woman releasing an egg every month (ovulation)
thickens the mucus from the cervix (entrance to the womb),
making it difficult for sperm to pass through to the womb and reach
an unfertilized egg
makes the lining of the womb thinner so that it is unable to
support a fertilized egg
 ADVANTAGES

Long term reversible contraception

Do not interfere with coitus
Has no estrogen related side effects
Can be used during breastfeeding
Can be used by adolescents
Rapid return of fertility
DISADVANTAGES
Expensive
Scarring at insertion site
SIDE EFFECTS
Weight gain
Irregular menstrual cycle with spotting, breakthrough bleeding,
amenorrhea, prolonged periods
Hair loss
Depression
Infection at insertion site
Local reaction of itching and pain at insertion site usually resolves
within one month
• 
CONTRAINDICATION
Pregnancy
Desire to get pregnant within the next 2 years
Undiagnosed vaginal bleeding
Norplant Considerations
Should be considered long term birth control
Requires no upkeep
Extremely effective in pregnancy prevention < 99 %
 BILATERAL TUBAL LIGATION

BTL is known as female sterilization as it

provides permanent contraception for
women who do not want any more children
It is safe and simple surgical procedure to
tie and cut the two fallopian tubes located on
both sides of the uterus.
MECHANISM OF ACTION
The service provider makes a small incision in the woman’s
abdomen and ties and cuts the two fallopian tubes on each
side of the uterus. These tubes carry eggs from the ovaries to
the uterus.
With the tubes blocked, the woman’s egg cannot meet the
man’s sperm. The woman continues to have menstrual
periods after BTL.
EFFECTIVENESS RATE: 99.5%
ADVANTAGES
Very effective
Permanent
Nothing to remember, no supplies needed, and no repeated
clinic visits required
N interference with sex
Increased sexual enjoyment
No hormonal side effects
No effect on breast milk
No known long-term side effects or health risk
Can be performed just after a woman gives birth
Can be performed at any day of the menstrual cycle provided the
service provider is reasonably sure that the women is not pregnant
DISADVANTAGES
Require minor surgery
Compared with vasectomy, BTL is:
-Slightly more risky
-Often more expensive
Considered to be permanent as reversal surgery is difficult,
expensive and success cannot be guaranteed
If pregnancy happens (very rare), there is a greater risk of
ectopic pregnancy compared to women who have not
undergone the procedure
Does not protect against STIs including HIV/AIDS
POSSIBLE SIDE EFFECTS
Common side effect: pain over the operative site which
diminishes in a day or two
Complication of surgery, which include the following, are
uncommon:
 Infection or bleeding at the incision
 Internal infection or bleeding
 Injury to internal organs
 Anesthesia risk:
With local anesthesia alone or with sedation, rare risk or
allergic reaction or overdose
With general anesthesia, occasional delayed recovery and side
effects. Complications are more several than with local anesthesia
TIMING OF BTL
Postpartum
Interval, or
Post abortion
WARNING SIGNS
Bleeding, pain, pus, heat, swelling or redness of the wound that
becomes worse or is persistent
•These are the signs of infection on the incision site
High grade fever
Fainting, persistent light- headedness, or extreme dizziness
Missed period, which signifies pregnancy
 VASECTOMY
Vasectomy is known as male sterilization as it provides
permanent contraception for men who decide they will not
want any more children
It is a safe, simple, and quick surgical procedure. The procedure
can be done in a clinic or office with proper infection prevention
practices
The procedure involves tying and cutting a segment of the vas,
which carries sperm.
No scalpel vasectomy is a small puncture on the scrotum to get
the vas.
•This is the DOH- approved procedure for vasectomy
MECHANISM OF ACTION
The service provider makes a puncture in the man’s scrotum
and ties and cuts the two vas.
Semen is still produced and found in the tubes after the
blocked vas
With the two vas blocked, there will be no sperm in the
semen.
ADVANTAGES
Very effective
Permanent
Nothing to remember except to use condoms or another affective method for at
least three months after the procedure
No interference with sex
Increase sexual enjoyment
No supplies to get, and no repeated clinic visits required
No known long-term side effects or health risks
Compared to BTL, vasectomy is:
 More effective
 Safer
 Easier to perform
 Less expensive
 Able to be tested for effectiveness at any time
 If pregnancy occurs in the man’s partner, less likely to be ectopic
DISADVANTAGES
Requires minor surgery
Not immediately effective
Must be considered as permanent
Does not protect against STIs including HIV/AIDS
POSSIBLE SID EFFECTS
Discomfort for 2-3 days
Pain in the scrotum, swelling and bruising which decreases
for about 2-3 days
 WARNING SIGNS

Severe bleeding or blood clots after the procedure

Redness, heat, swelling, pain at the incision site
Pus at the incision site
Pain lasting for months
 Source of supply for
contraceptive methods
Public sector Private medical Other private

70
65
57
44 44 47
38 37
27
18 17
13
5 5 9

Daily pill Monthly pill Injectables Condom IUD*

Intention to use contraception
in the future

45
42

13

Intends to use Does not intend Unsure

Preferred method of Contraception
for future use

34
26

15

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 Some reasons cited by women for
not intending to use contraception
Health concerns
26%

Difficult to get pregnant 24%

Wants more children 10%
Opposed to family planning 9%
Infrequent sex/no sex 8%
Fear side effects 6%